Sweet as Sugar: The World of Sugar Substitutes and Sweeteners
Tina Juehling
Introduction
Currently, the average per capita sugar consumption in Europe is around 36 kg per year1. However, the World Health Organization (WHO) recommends that no more than 10 percent of the daily calorie intake should come from sugar and a maximum of 5 percent would be even better. On a daily intake of 2,000 calories, this would be equivalent to 25 g of sugar. This is because high sugar consumption increases the risk of becoming overweight and of developing diseases like diabetes, high blood pressure, and heart disease. It also harms teeth by promoting dental cavities2. Growing concerns about the consequences of excessive sugar consumption have led to increased interest in alternatives. Sugar substitutes and sweeteners, which serve as alternatives to conventional sugar, have become a focus of modern nutrition and are used in a wide range of foods to reduce calories or sugar content. But what exactly are low-calorie sweeteners? How do they differ from sugar in taste, structure, and everyday use? And are they really a healthy alternative?
Sugar Substitutes and Sweeteners as Sugar Alternatives
Sugar substitutes, such as xylitol, erythritol, sorbitol, and mannitol (see table 1 for more examples), are carbohydrates that have a lower impact on blood sugar levels than conventional sugar. They are often derived from natural sources such as fruit or corn and, while chemically similar to sugar, they are metabolized more slowly in the body resulting in a lower insulin response. This makes them particularly suitable for diabetics or people who need to control their blood sugar levels. Another advantage is that they contain fewer calories than sugar.
Sweeteners, such as aspartame, saccharin, sucralose, and stevia, are chemical compounds that have a strong sweet taste but few or no calories. They are significantly sweeter than sugar and are often used in very small amounts to achieve the desired sweet taste. These sweeteners are not metabolized and therefore do not affect blood sugar levels, making them also suitable for diabetics. In everyday life sugar substitutes and sweeteners can be found in a wide range of products, including sugar-free drinks, sweets, bakery products, yoghurts, and even chewing gum. They allow people to satisfy their sweet cravings without risking the negative health effects of sugar. However, sugar substitutes and sweeteners can vary in taste and texture. Some may have a slightly bitter aftertaste or, in high concentrations, may have a laxative effect. They can also change the texture of foods, especially in baked goods3.
Table 1: Examples of Sugar Substitutes and Sweeteners
| Sugar Substitutes | Sweeteners (EU Approved) | ||
| Erythritol (E 968) | Comes from mushrooms, cheese, fruits (strawberries, plums), or pistachios | Aspartame (E 962) | About ×200 sweeter than sugar |
| Isomalt (E 953) | Obtained from sucrose | Cyclamat (E 952) | Pronounced sugar-like taste, ×35 sweeter than sugar |
| Mannitol (E 421) | Obtained from fructose. Occurs naturally in mushrooms, algae, figs | Saccharin (E 954) | Oldest synthetic sweetener, ×300 to ×700 sweeter than sugar |
| Maltitol (E 965) | Obtained from maltose | Sucralose (E 955) | Obtained from sucrose, ×600 sweeter than sugar |
| Lactitol (E 966) | Not natural, obtained by catalytic hydrogenation of lactose | Stevioside (E 960) | Naturally obtained from the Stevia plant, ×70 to ×450 sweeter than sugar |
| Sorbitol (E 420) | Found in apples, plums, and peaches | Neotame (E 961) | ×7000 to ×13,000 sweeter than sugar |
| Xylitol (E 967) | Naturally occuring in many fruits and vegetables | Thaumatin (E 957) | Naturally occurring sweetener, ×2000 to ×3000 as sweet as sugar |
"In everyday life sugar substitutes and sweeteners can be found in a wide range of products, including sugar-free drinks, sweets, bakery products, yoghurts, and even chewing gum. They allow people to satisfy their sweet cravings without risking the negative health effects of sugar. However, sugar substitutes and sweeteners can vary in taste and texture. Some may have a slightly bitter aftertaste or, in high concentrations, may have a laxative effect."
Sweet, Sweeter, and Too Sweet
In addition to the benefits described above, the use of sugar substitutes and sweeteners also has some drawbacks. The mentioned sweeteners can cause bloating and diarrhea when consumed in excess. There is also discussion about whether sweeteners can stimulate appetite due to their sweet taste, something the scientific community is still divided upon. In one study, scientists fed mice with various sweeteners and this altered the gut flora of the animals, while a gain in weight was observed. Similar effects have been observed in humans, where the sweetener sucralose was found to stimulate the appetite center in the brains of women and in overweight people regardless of gender4.
Furthermore, there are concerns regarding the risk of cancer and addiction potential. In a study from 2023, a high level of erythritol in the blood was associated with a higher risk of stroke, heart attack, and other cardiovascular events compared to individuals with low levels of erythritol in the blood. In the same study, in vivo injection of erythritol in 12 to 14-week-old mice promoted thrombus formation, which may explain pathophysiologically the increased risk of strokes and heart attacks5.
Conclusions
The choice between sugar substitutes and sweeteners depends on individual preferences, health needs, and personal goals. When purchasing products containing sugar substitutes and sweeteners, consumers should read labels carefully and be aware of the potential effects. People with sensitive stomachs may need to limit their consumption of sugar substitutes to avoid unwanted side effects. It is also important to maintain a balanced diet and not rely solely on products containing sugar substitutes or sweeteners. Overall, sugar substitutes and sweeteners offer a useful alternative to conventional sugar, especially for people with specific dietary needs. Their use can help reduce the calorie content of foods and keep blood sugar levels stable. However, it is important to use them with caution and be aware of the potential advantages and disadvantages. The use of sweeteners authorized in the EU is considered safe for as long as the respective maximum permitted amounts are not exceeded6. Scientific research is ongoing and new findings may influence the use of sweeteners in the future.
References
1. OECD-FAO Agricultural Outlook 2021-2030. Table C.23.2 - Sugar projections: Consumption, per capita. https://doi.org/10.1787/4ad4cf3a-en.
2. World Health Organization. Guideline: Sugar intake for adults and children. 2015. https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1.
3. Quitral V, Valdés J, Umaña V, et al. The role of non-caloric sweeteners in Sensory characteristics of pastry products. Foods 2019; 8(8): 329. https://doi.org/10.3390/foods8080329.
4. Yunker AG, Alves JM, Luo S, et al. Obesity and sex-related associations with differential effects of sucralose vs sucrose on appetite and reward processing: a randomized crossover trial. JAMA Netw Open 2021; 4(9): e2126313. https://doi.org/10.1001/jamanetworkopen.2021.26313.
5. Witkowski M, Nemet I, Alamri H, et al. The artificial sweetener erythritol and cardiovascular event risk. Nat Med 2023; 29: 710–718. https://doi.org/10.1038/s41591-023-02223-9.
6. European Food Safety Authority. Sweeteners 2024. https://www.efsa.europa.eu/en/topics/topic/sweeteners.
